The case of the month is an actual patient of The Turek Clinic.
“Doctor Turek, thanks for talking with me. I’ve been married to John for 30 years and lately it seems like his sex drive which has been pretty even-steven is now much lower. Not only that, his erections don’t last very long and he’s grumpier now. He reminds me of the way I felt 10 years ago when I went through menopause. Do men have a menopause?”
Well, to be honest, the answer is: “Yes, they kinda do.” It’s not called that, but the terms “andropause” or the “male climacteric” have been used to describe it. In the field, we call it “androgen deficiency in the aging male” (ADAM) or “symptomatic late onset hypogonadism” (SLOH) because we prefer big long names for medical things. However coined, these terms all refer to declines or deficiencies in the male hormone testosterone with age. And for many men, the treatment is robustly simple: get more juice on board with testosterone replacement. But, of course, taking ‘roids is a hot topic that always kicks up a storm of controversy.
Testosterone and You
Before we blame the decline of the male human race on a single hormone, let’s review some facts about testosterone:
- Testosterone decreases as a function of age in all men. Believe it or not, this starts happening by age 30 years.
- Testosterone decreases by as much as 50% between ages 25 and 75 years.
- The degree of testosterone decline varies by individual.
- Unlike menopause, testosterone typically shows a gradual decline with age and does not fall suddenly or dramatically. As a general rule of thumb, testosterone levels decrease by 1% annually after the age of 40 years.
- Other hormones such as dehydroepiandrosterone (DHEA), growth hormone, thyroxine and melatonin also decrease with age and may influence ADAM-related symptoms.
- Dihydrotestosterone (DHT), a testosterone by-product and even more potent androgen, does not decline appreciably with age.
- Not all men with ADAM symptoms will have low testosterone levels.
- Not all men with ADAM symptoms will respond to testosterone therapy.
- It is estimated that only 10% of men with truly low testosterone levels have been diagnosed with them.
ADAM and You
The bottom line here is that an ADAM diagnosis is not as simple as you might think. Although sexual symptoms such as erectile dysfunction and low sex drive are fairly specific for low testosterone, having less energy or feeling weaker, having memory issues or declining work performance, falling asleep after dinner, enjoying life less, being less able to play sports and losing height can also be part of normal aging in some men. Not only that, common medical disorders of the thyroid, adrenal gland, kidney, liver or heart should always be screened first as they may mimic ADAM symptoms. Finally, testosterone levels can fall from medications, poor diet, excessive alcohol consumption, illness, lack of sleep, stress, injury and surgery which are conditions which are (and should be) treatable without resorting to testosterone supplements.
But, even if ADAM is a completely different hormonal beast than menopause, the quality of life impairments that men and women experience with these phenomena could be equally powerful. And that alone is reason to believe in a “male menopause.” Absolutely, get Mr. John evaluated!